PCI just as successful when patients have a history of TAVR—but there are some added risks
Percutaneous coronary intervention (PCI) success rates are comparable for patients who have and have not previously undergone transcatheter aortic valve replacement (TAVR), according to a new study published in The American Journal of Cardiology.[1]
However, researchers noted, patients with a history of TAVR are associated with longer fluoroscopy times and a greater risk of adverse events.
“As the indications for TAVR expand, it will be increasingly important to understand the risks and benefits of PCI in post-TAVR patients presenting with symptomatic coronary artery disease,” wrote first author Christina Lalani, MD, a researcher with Beth Israel Deaconess Medical center and Harvard Medical School, and colleagues. “This is especially relevant given some of the technical issues with post-TAVR PCI, such as challenges with coronary engagement and guiding catheter support, especially with self-expanding valves.”
Lalani et al. explored data from the American College of Cardiology’s CathPCI Registry, focusing on more than 52,000 patients who underwent TAVR from 2011 to 2017. All patients were Medicare fee-for-service beneficiaries. While 10.2% of those patients experienced an acute myocardial infarction (AMI) in the next five years, 5.1% underwent PCI. The study’s authors then compared this group with more than 5,000 propensity-score matched patients who underwent PCI without a history of TAVR.
Overall, PCI success rates were 91.6% for patients with a history of TAVR and 92.4% with no history of TAVR; this was not viewed as a statistically significant difference. The mean fluoroscopy times, meanwhile, were 21.9 minutes for patients with a history of TAVR and 17.7 minutes for patients with no history of TAVR. Patients with a history of TAVR also had a higher post-procedural stroke rate (0.8% vs. 0.4%) and higher bleeding event rate (5.1% vs. 2.9%).
Looking at three-year outcomes, patients with a history of TAVR were more likely to require repeat PCI, but the AMI rate was comparable for the two groups. Long-term stroke and death were also more common for patients with a history of TAVR.
Lalani and colleagues noted that the longer fluoroscopic time and increased risk of a bleeding event found in patients with a history of TAVR were likely explained by the fact that their PCI procedures would be more complex and require more time. It is also possible that these patients were not as likely to be prescribed blood thinners or anti-platelet agents, they explained, but they did not have access to that data.
“A third potential driver of the differences in bleeding rates is the presence of intrinsic differences in bleeding propensity between patients with aortic stenosis and those without,” the authors added.
The study did have certain limitations. Because all patients were Medicare fee-for-service beneficiaries, for example, these data may not reflect how outcomes would look for other patient populations. Also, the type of TAVR valve each patient received was not tracked; this is a detail that could potentially help clinicians take more away from these findings.
Click here to read the full study.
Michael has more than 18 years of experience as a professional writer and editor. He has written at length about cardiology, radiology, artificial intelligence and other key healthcare topics.